Intestinal Research

Original Articles

Inflammatory bowel diseases

Adherence to Asacol once daily versus divided regimen for maintenance therapy in ulcerative colitis: a prospective, multicenter, randomized study: Soo-Kyung Park, Sang Hyun Park, Chang Soo Eun, Geom Seog Seo, Jong Pil Im, Tae Oh Kim, Dong-Il Park; Intest Res 2019;17(3):349-356. Published online February 8, 2019; DOI: https://doi.org/10.5217/ir.2018.00064

Background/Aims
A once-daily (OD) regimen of 5-aminosalicylic acid (5-ASA) was easier to comply with than a divided daily (DD) regimen, and that treatment efficacy for ulcerative colitis (UC) was not affected by the dosing regimen. This study evaluated treatment adherence of OD and DD dosing in the Korean UC patients.
Methods
This study was a prospective, multicenter, randomized trial. UC patients were enrolled who have been in remission for more than 3 months. Patients were randomly assigned to the OD or DD group in a 1:1 ratio. The primary endpoint was adherence rate measured by tablet counts and self-reported adherence rate at 3, 6, 9, and 12 months. The relapse rate was measured at 1 year.
Results
Data from the 180 patients who were randomized were analyzed. Both self-reported adherence rate and adherence rate measured by tablet counts were not different at every points, including 1 year. The patients’ satisfaction of the OD group was higher than that of the DD group (P<0.001). At 1 year, 91.2% and 95.5% of patients in the OD group and DD group had maintained clinical remission, respectively (P=0.37).
Conclusions
The adherence rates were not different between the OD group and DD group. The patients’ satisfaction was higher in the OD group than in the DD group. 5-ASA OD dosing might have the same effect as DD for the maintenance of UC remission.

Citations

Citations to this article as recorded by

Non-Adherence Rate to Oral Mesalamine in Ulcerative Colitis Patients: A Systematic Review with Meta-Analysis
Cristiano Pagnini, Elisabetta Antonelli, Barbara Scrivo, Maria Cappello, Marco Soncini, Roberto Vassallo, Giammarco Mocci, Maria Carla Di Paolo
Journal of Personalized Medicine.2025; 15(4): 123. CrossRef
Improving Medication Adherence Levels in Inflammatory Bowel Disease (IBD) Patients: A Narrative Evidence-Based Review
Obreniokibo Amiesimaka, Kristina Aluzaite, Rhiannon Braund, Michael Schultz
Patient Preference and Adherence.2024; Volume 18: 905. CrossRef
Continuing or stopping 5‐aminosalicylates in patients with inflammatory bowel disease on anti‐TNF therapy: A nationwide population‐based study
Jeongkuk Seo, Seonok Kim, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong‐Hoon Yang, Jeong‐Sik Byeon, Seung‐Jae Myung, Suk‐Kyun Yang, Ye‐Jee Kim, Byong Duk Ye
Alimentary Pharmacology & Therapeutics.2024; 60(3): 389. CrossRef
Researching Interventions to Improve Medication Adherence in Ulcerative Colitis Patients
Mila Palma Pacheco, Flora Maria Lorenzo Fortes, Raquel Rocha dos Santos, Genoile Oliveira Santana Silva
Journal of Coloproctology.2021; 41(01): 096. CrossRef
Treatment of inflammatory bowel diseases: focusing on 5-aminosalicylates and immunomodulators
You Sun Kim
Journal of the Korean Medical Association.2021; 64(9): 596. CrossRef
Living with ulcerative colitis in Germany: a retrospective analysis of dose escalation, concomitant treatment use and healthcare costs
Axel Dignass, John Waller, Joseph C. Cappelleri, Irene Modesto, Agnes Kisser, Lena Dietz, Marco DiBonaventura, Robert Wood, Melanie May, Berit Libutzki, Danielle Bargo
Journal of Medical Economics.2020; 23(4): 415. CrossRef
Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis
Alistair Murray, Tran M Nguyen, Claire E Parker, Brian G Feagan, John K MacDonald
Cochrane Database of Systematic Reviews.2020;[Epub] CrossRef

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IBD

Is Clostridium difficile infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea: Dae Bum Kim, Kang-Moon Lee, Sang Hyoung Park, You Sun Kim, Eun Soo Kim, Jun Lee, Sung-Ae Jung, Geom Seog Seo, Ji Min Lee; Intest Res 2018;16(2):267-272. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.267

Abstract PDF PubReader ePub

Background/Aims

Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups.

Methods

This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy.

Results

Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI.

Conclusions

CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.

Citations

Citations to this article as recorded by

Association of Clostridium difficile infection with clinical outcomes of patients with inflammatory bowel disease: A meta-analysis
Hai-Xin Qi, Qi Wang, Gui-Qun Zhou
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India
Sandeep Mundhra, David Thomas, Saransh Jain, Pabitra Sahu, Sudheer Vuyyuru, Peeyush Kumar, Bhaskar Kante, Rajesh Panwar, Peush Sahni, Rama Chaudhry, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
Indian Journal of Gastroenterology.2023; 42(3): 411. CrossRef
The Prevalence and Risk Factors of Clostridioides difficile Infection in Inflammatory Bowel Disease: 10-Year South Korean Experience Based on the National Database
Eun Mi Song, Arum Choi, Sukil Kim, Sung Hoon Jung
Journal of Korean Medical Science.2023;[Epub] CrossRef
Clostridioides Infection in Patients with Inflammatory Bowel Disease
Mi Rae Lee, Eun Soo Kim
The Korean Journal of Gastroenterology.2022; 80(2): 66. CrossRef
Clostridium difficile in ulcerative colitis; a retrospective study
O. V. Knyazev, A. V. Kagramanova, M. E. Chernova, I. A. Koroleva, A. I. Parfenov
Almanac of Clinical Medicine.2018; 46(5): 474. CrossRef

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Statement

Use of Thiopurines in Inflammatory Bowel Disease: A Consensus Statement by the Korean Association for the Study of Intestinal Diseases (KASID): Kang-Moon Lee, You Sun Kim, Geom Seog Seo, Tae Oh Kim, Suk-Kyun Yang, IBD Study Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2015;13(3):193-207. Published online June 9, 2015; DOI: https://doi.org/10.5217/ir.2015.13.3.193

Abstract PDF PubReader

Background/Aims

For decades, thiopurines have been the mainstay of inflammatory bowel disease (IBD) treatment and will play an important role in the future. However, complex metabolism and various side effects limit the use of these potent drugs in clinical practice. The Korean Association for the Study of Intestinal Diseases developed a set of consensus statements with the aim of guiding clinicians on the appropriate use of thiopurines in the management of IBD.

Methods

Sixteen statements were initially drafted by five committee members. The quality of evidence and classification of recommendation were assessed according to the Grading of Recommendations Assessment, Development and Evaluation system. The statements were then circulated to IBD experts in Korea for review, feedback, and then finalized and accepted by voting at the consensus meeting.

Results

The consensus statements comprised four parts: (1) pre-treatment evaluation and management strategy, including value of thiopurine S-methyltransferase screening, dosing schedule, and novel biomarkers for predicting thiopurine-induced leukopenia; (2) treatment with thiopurines with regards to optimal duration of thiopurine treatment and long-term outcomes of combination therapy with anti-tumor necrosis factors; (3) safety of thiopurines, especially during pregnancy and lactation; and (4) monitoring side effects or efficacy of therapy using biomarkers.

Conclusions

Thiopurines are an effective treatment option for patients with IBD. Management decisions should be individualized according to the risk of relapse and adverse events.

Citations

Citations to this article as recorded by

Differences in the risk of clinical failure between thiopurine and methotrexate in bio-naïve patients with Crohn’s disease: a Korean nationwide population-based study
Yu Kyung Jun, Eunjeong Ji, Hye Ran Yang, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Hyuk Yoon
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef
Innovating Thiopurine Therapeutic Drug Monitoring: A Systematic Review and Meta-Analysis on DNA-Thioguanine Nucleotides (DNA-TG) as an Inclusive Biomarker in Thiopurine Therapy
Ahmed B. Bayoumy, A. R. Ansari, C. J. J. Mulder, K. Schmiegelow, Timothy Florin, N. K. H. De Boer
Clinical Pharmacokinetics.2024; 63(8): 1089. CrossRef
Azathioprine for people with multiple sclerosis
Ben Ridley, Francesco Nonino, Elisa Baldin, Ilaria Casetta, Gerardo Iuliano, Graziella Filippini
Cochrane Database of Systematic Reviews.2024;[Epub] CrossRef
Inflammatory Bowel Disease: Pathophysiology, Treatment, and Disease Modeling
Jiryeon Jang, Sehoon Jeong
BioChip Journal.2023; 17(4): 403. CrossRef
Association of genetic polymorphism of NUDT15, TPMT and ITPA gene in the toxicity and efficacy of azathioprine-based regimen in Egyptian inflammatory bowel disease patients
Nashwa Eltantawy, Islam Abd El-Hamid El-Zayyadi, Ahmed A. Elberry, Layla M. Salah, Mohamed E. A. Abdelrahim, Amira B. Kassem
Beni-Suef University Journal of Basic and Applied Sciences.2023;[Epub] CrossRef
A review article of inflammatory bowel disease treatment and pharmacogenomics
Nashwa Eltantawy, Islam Abd El-Hamid El-Zayyadi, Ahmed A. Elberry, Layla M. Salah, Mohamed E. A. Abdelrahim, Amira B. Kassem
Beni-Suef University Journal of Basic and Applied Sciences.2023;[Epub] CrossRef
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Devendra Desai, Anuraag Jena, Vishal Sharma, Toshifumi Hibi
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European Journal of Neurology.2022; 29(8): 2343. CrossRef
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Mukesh Kumar Ranjan, Bhaskar Kante, Sudheer Kumar Vuyyuru, Peeyush Kumar, Sandeep K Mundhra, Rithvik Golla, Raju Sharma, Peush Sahni, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
Journal of Gastroenterology and Hepatology.2022; 37(8): 1544. CrossRef
NUDT15Genotyping in Thiopurine Drug Therapy
Jong Kwon Lee, Rihwa Choi, Soo-Youn Lee
Laboratory Medicine Online.2022; 12(4): 217. CrossRef
Association of genetic variants in TPMT, ITPA, and NUDT15 with azathioprine-induced myelosuppression in southwest china patients with autoimmune hepatitis
Qiang Miao, Lin Yan, Yanhong Zhou, Yi Li, Yuangao Zou, Lanlan Wang, Yangjuan Bai, Junlong Zhang
Scientific Reports.2021;[Epub] CrossRef
Treatment of inflammatory bowel diseases: focusing on 5-aminosalicylates and immunomodulators
You Sun Kim
Journal of the Korean Medical Association.2021; 64(9): 596. CrossRef
Randomised clinical trial: dose optimising strategy by NUDT15 genotyping reduces leucopenia during thiopurine treatment of Crohn's disease
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Pharmacogenetics-based personalized treatment in patients with inflammatory bowel disease: A review
Ji Young Chang, Jae Hee Cheon
Precision and Future Medicine.2021; 5(4): 151. CrossRef
Sexual Dysfunction and Fertility Problems in Men with Inflammatory Bowel Disease
Yong Eun Park, Tae Oh Kim
The World Journal of Men's Health.2020; 38(3): 285. CrossRef
Genotype-based Treatment With Thiopurine Reduces Incidence of Myelosuppression in Patients With Inflammatory Bowel Diseases
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Adjustment of azathioprine dose should be based on a lower 6‐TGN target level to avoid leucopenia in NUDT15 intermediate metabolisers
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NUDT15 genotyping during azathioprine treatment in patients with inflammatory bowel disease: implications for a dose-optimization strategy
Ye Xu, Yu-Qi Qiao, Han-Yang Li, Mi Zhou, Chen-Wen Cai, Jun Shen, Zhi-Hua Ran
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Complete remission of refractory pemphigus vulgaris in a Chinese patient with mutated NUDT15 by combination of minimal doses of azathioprine and prednisone
Xing‐Li Zhou, Tong‐Ying Zhan, Yan‐Hong Zhou, Krista Shrestha, Tian‐Jiao Lan, Wei Li
Dermatologic Therapy.2020;[Epub] CrossRef
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Jaewoan Bae, Byung-Ho Choe, Ben Kang
Yeungnam University Journal of Medicine.2020; 37(4): 332. CrossRef
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Xiang Fei, Qing Shu, Huaijun Zhu, Bingzhu Hua, Shiying Wang, Ling Guo, Yun Fang, Weihong Ge
Frontiers in Pharmacology.2018;[Epub] CrossRef
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Hilal Ahmad, Vijay L. Kumar
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Sheng Zhang Lim, Eng Wee Chua
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Jong Pil Im, Byong Duk Ye, You Sun Kim, Joo Sung Kim
The Korean Journal of Internal Medicine.2018; 33(1): 28. CrossRef
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Second Korean Guideline for the Management of Ulcerative Colitis
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Jong Pil Im
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X. Zhu, X.‐D. Wang, K. Chao, M. Zhi, H. Zheng, H.‐L. Ruan, S. Xin, N. Ding, P.‐J. Hu, M. Huang, X. Gao
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Six Cases of Lung Injury Following Anti-tumour Necrosis Factor Therapy for Inflammatory Bowel Disease
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Original Article

Usefulness of Gastroscope in Patients with Incomplete Colonoscopy: Bong Joon Yang, Yong Hwan Ahn, Seong Ryeol Oh, Jin Soo Chung, Sae Ron Shin, Suck Chei Choi, Yong Ho Nah, Geom Seog Seo; Intest Res 2013;11(1):41-45. Published online January 31, 2013; DOI: https://doi.org/10.5217/ir.2013.11.1.41

Abstract PDF: Background/Aims
Conventional colonoscopy is limited in some patients with several causes, such as fixed angulation, extensive loop or adhesion. Therefore, small-caliber scopes are considered alternatives to unsuccessful conventional colonoscopy. The aim of this study is to evaluate the usefulness of gastroscope in patients with unsuccessful colonoscopy. Methods: From May 2008 to April 2009, a total of 2,548 colonoscopies were performed in Wonkwang University Hospital. The gastroscope was used subsequently when conventional colonoscopy failed. Results: There were 27 cases (1.06%) of unsuccessful colonoscopy. The causes of failure were assessed as fixed angulation of the sigmoid colon (59.2%, 16/27), excessive looping (14.8%, 4/27), stricture (14.8%, 4/27), sigmoid diverticulosis (7.4%, 2/27), and adhesion of transverse colon (3.7%, 1/27). The average time of intubation to cecum with the gastroscope was 7 minutes and 28 seconds (range, 2 to 20 minutes). With the gastroscope, 77.8% (21/27) were intubated to the cecum. The pain score of gastroscope was reduced, as compared with that of conventional colonoscopy (4.95 vs. 5.94, P<0.001). Conclusions: Gastroscope would be a useful alternative tool in patients with unsuccessful colonoscopy. (Intest Res 2013;11:41-45)

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Review

Clostridium difficile Infection: What's New?: Geom Seog Seo; Intest Res 2013;11(1):1-13. Published online January 31, 2013; DOI: https://doi.org/10.5217/ir.2013.11.1.1

Abstract PDF

Since 2000, Clostridium difficile infection has increased substantially in both hospital-acquired and community-acquired diarrhea, not only in North America but also in Europe. There was a steady increase in the incidence and severity of C. difficile infection over the past decade, associated with significantly higher morbidity and mortality. The major risk factors for C. difficile infection appear to be the use of new antimicrobial therapy, long-term hospitalization in old age and emerging hypervirulent strains, such as various ribotypes. Rapid and accurate diagnosis of C. difficile infection is necessary for appropriate treatment as well as reliable epidemiological data. Currently available treatment options are withdrawal of the suspected offending antibiotics and then treating patients with highly effective antibiotics for C. difficile. Multiple recurrence or acute fulminant C. difficile infection could be treated with fecal microbiota transplantation. Promising therapies for treating C. difficile infection should always be equipped with high efficacy and safety in the future. (Intest Res 2013;11:1-13)

Citations

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The Korean Journal of Gastroenterology.2016; 67(2): 61. CrossRef
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10 Crossref

Original Article

Risk Factors for Recurrent Clostridium difficile Infection: Han Seung Ryu, Yong Sung Kim, Geom Seog Seo, Yu Min Lee, Suck Chei Choi; Intest Res 2012;10(2):176-182. Published online April 30, 2012; DOI: https://doi.org/10.5217/ir.2012.10.2.176

Abstract PDF

Background/Aims
Clostridium difficile infection (CDI) is a common nosocomial infection associated with substantial morbidity, mortality and increased medical care costs. Although most patients initially respond to therapy, with either metronidazole or vancomycin, about 15-20% of patients experience recurrence. The aim of this study was to analyze the risk factors related to recurrent CDI (RCDI). Methods: We retrospectively reviewed data, from patients diagnosed with CDI during admission at a university hospital between January 2000 and December 2006, for comparison with data from RCDI patients. Results: Among a total of 294 CDI patients, 32 (10.8%) had experienced RCDI. Risk factors for RCDI included anemia, congestive heart failure, respiratory infection, time between admission and CDI diagnosis, duration of antibiotic therapy prior to CDI diagnosis, tube feeding, and gastrointestinal endoscopy. Multivariate analysis revealed that tube feeding was associated with recurrence (odds ratio, 3.65; 95% confidence interval, 1.38-9.65; P=0.009). Conclusions: Patients who received tube feeding were at increased risk of RCDI. Targeting these patients for preventive strategies may contribute to a reduction in the incidence of RCDI. (Intest Res 2012;10: 0-182)

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Clinical Microbiology and Infection.2022; 28(3): 321. CrossRef
European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults
Joffrey van Prehn, Elena Reigadas, Erik H. Vogelzang, Emilio Bouza, Adriana Hristea, Benoit Guery, Marcela Krutova, Torbjorn Norén, Franz Allerberger, John E. Coia, Abraham Goorhuis, Tessel M. van Rossen, Rogier E. Ooijevaar, Karen Burns, Bente R. Scharvi
Clinical Microbiology and Infection.2021; 27: S1. CrossRef
Biological characteristics associated with virulence in Clostridioides difficile ribotype 002 in Hong Kong
Ka Yi Kong, Thomas N. Y. Kwong, Hung Chan, Kristine Wong, Samuel S. Y. Wong, Anu P. Chaparala, Raphael C. Y. Chan, Lin Zhang, Joseph J. Y. Sung, Jun Yu, Peter M. Hawkey, Margaret Ip, William K. K. Wu, Sunny H. Wong
Emerging Microbes & Infections.2020; 9(1): 631. CrossRef
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Infection Control & Hospital Epidemiology.2015; 36(4): 452. CrossRef
Risk Factors for Delayed Recurrence ofClostridium difficileInfection
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Intestinal Research.2014; 12(4): 299. CrossRef
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Intestinal Research.2013; 11(1): 1. CrossRef

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Selected Summary

Long-term Effect of Aspirin on Colorectal Cancer Incidence and Mortality: 20-year Follow-up of Five Randomised Trials (Lancet 2010;376:1741-1750): Geom Seog Seo; Intest Res 2010;8(2):205-206. Published online December 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.2.205

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Case Report

A Case of Asymptomatic Congenital Inverted Appendix: Ki Hoon Kim, Geom Seog Seo, Chang Soo Choi, Sae Ron Shin, Suck Chei Choi; Intest Res 2009;7(2):114-117. Published online December 30, 2009

Abstract PDF: An inverted appendix is a rare condition that develops in conjunction with pathologic or anatomic conditions, such as polyps, worms, carcinomas, mucoceles, fecaliths, or post-appendectomy. There are few reports of congenital inverted appendices. The clinical symptoms can range from no symptoms to acute or chronic lower abdominal pain, as in appendicitis. An inverted appendix can be diagnosed by barium enema, colonoscopy, ultrasound, and CT scan, but few cases are reported pre-operatively. Indeed, most cases are diagnosed intra-operatively. Because an inverted appendix is often misdiagnosed as a polyp during colonoscopy, it is important to differentiate an inverted appendix from a polyp or tumor for therapeutic planning. We report herein a 76-year-old woman who had no clinical symptoms of a congenital inverted appendix which had been observed without any treatment or symptoms over a 7 year period. (Intest Res 2009;7:114-117)

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Selected Summary

Influence of Trough Serum Levels and Immunogenicity on Long-term Outcome of Adalimumab Therapy in Crohn's Disease (Gastroenterology 2009;137:1628-1640): Geom Seog Seo; Intest Res 2009;7(2):135-136. Published online December 30, 2009

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Case Reports

A Tuberculous Peritonitis Presenting as Submucosal Tumors: Chang Soo Choi, Geom Seog Seo, Ki Hoon Kim, Bong Joon Yang, Yong Hwan Ahn, Suck Chei Choi; Intest Res 2009;7(1):60-63. Published online June 30, 2009

Abstract PDF: Tuberculous peritonitis is not an uncommon disease, but the diagnosis is often missed and delayed because of the variability of disease presentation and non-specific clinical manifestations. In this report, we discuss a rare case of tuberculous peritonitis which presented as a submucosal mass in the colon. A 61-year-old woman registered at our hospital for a physical check-up. She had a weight loss of 3 kg over the past 6 months. The colonoscopic findings showed submucosal lesions (4 and 6 mm in size, yellow in color, and hard) which were suspected to be a carcinoid tumor. However, an abdomen-pelvic CT scan and laparoscopic findings suggested peritoneal tuberculosis. The result of laparoscopic biopsies was chronic granulomatous inflammation without caseous necrosis. After the standard anti-tuberculosis medications for 6 months, the previous lesions on the CT scan had resolved. (Intest Res 2009;7:60-63)

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A Case of Rifampin-induced Severe Thrombocytopenia and Leukopenia in a Patient with Intestinal Tuberculosis: Ji Woong Kim, Gum Mo Jung, Eun Young Cho, Chang Soo Choi, Geom Seog Seo, Jin Woong Cho, Suck Chei Choi, Yong Ho Nah; Intest Res 2006;4(1):64-68. Published online June 30, 2006

Abstract PDF: Drug induced thrombocytopenia is a relatively not uncommon and potentially serious side effect of therapy. It's characterized by thrombocytopenia, petechia, purpuric lesions and occasionally serious bleeding such as intracranial hemorrhage. The patient was 24 year-old female who was given rifampin 600mg daily for treatment of intestinal tuberculosis. Rifampin-induced immune thrombocytopenia was occurred 25 days after initiating therapy. Platelet and leukocyte count were 23,000/mm³, 2,850/mm³,respectively. Two week after discontinuation of antituberculous medication, platelet count was recovered. We report this case with a review of literature. (Intestinal Research 2006;4:64-68)

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